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DavidfromTexas

DavidfromTexas

Hi, @ChessieCat I actually did do the search first. Believe me, I have read more on this site than I would like at this point.

The only reason I ask the question is because from what I have read in those spots on the site, there seems to be conflicting statements from different users from post to post. Perhaps signalling that nobody actually knows if regular anti-histamine use combined with regular anti-depressants is safe or not.

I think my plan will be to not take any other medications besides my antidepressant and vitamin d. However, if I run into more serious allergy problems that need addressing, I won’t know what to do.

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Onmyway

Onmyway

sorry I have been away from your thread. I have been struggling with intense withdrawal after my meagre 6% cut after the 2.5 reintstament (nausea, insomnia, anxiety, anger, dizziness, pins and needles). I see that ChessieCat has answered your questions.

I am really sorry that you are going through a lot of intense emotions. Grieving a lost relationship is not easy but has to be done in order to be able to move on. Withdrawal makes it just that much harder. Are you able to occupy yourself with other things - like videogames, sports with people, board games? Do you know about meetup.com where you can meet people with common interests? Can you read? I find Dave Barry's books quite funny if you can read. Glad that you are hanging out with your roommates. Every little bit helps in withdrawal.

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Guilietta

Guilietta

Yeah, about holding, I am going to hold for quite a while actually as soon as I can find the reinstatement dose that is working for me. I am thinking of taking that dose with no change for several months to allow for more healing before starting to reduce again.

I would stay at the reinstatement dose and give my body a chance to get used to the lower dose. And when you just need a break - holding for 2-3 weeks can be a good thing.

1:30am Felt much better by the end of work. Decided to keep with the 1mg dose

1:45am Took 1mg dose.

3:00am Went to sleep.

FRIDAY AUG 2 (day 9)

8:45am Woke up. Good nights sleep. Did not wake up with the feeling of doom I have had lately.

10:30am ENT follow up appt.

I am noticing at this point that I am feeling MUCH better today. I do not have the underlying anxiety feeling I’ve been having, no underlying panic or sense of doom, all while still reading and responding to posts on this site. So it’s not like I’m avoiding thinking about the issues either.

12:00am Lunch.

12:30-5:00pm Taking care of tasks at home, worked on some vocals as well.

Today has been very nice.

5:30pm Dinner before a meeting with my new agency.

6:30-10:00pm Looong meeting, not thinking about my issues at all, focused the entire time. Lots of people here and I was very sociable.

I have had a great, seemingly back to normal day. I don’t know why. I pray to God that it continues.

1:30am Took 1 mg pill.

2:00 am Went to sleep.

2:40am Woke up from a nightmare, sweating. Pretty soon was back to sleep.

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DavidfromTexas

DavidfromTexas

You know, I think I have noticed a TINY drop in the EXTENT of my rumination. But the difference I notice more than that is that even though I am still ruminating about my issues quite a bit, that rumination isn’t leading to me crying like I was...I feel a little less emotionally on edge. So the rumination doesn’t end up pushing me over the edge emotionally like it had been. I’m still really sad about things for sure, but the outward emotional response has dissipated a little it seems.

That said, I am still waking up most days with that underlying feeling of anxiety and gloomy doom-ish feeling. I believe that initial feeling upon waking up is what starts me down the road of rumination and losing sight of a good future. I don’t know if that just has something to do with the body when waking up? I was so happy when I woke up a couple days ago and didn’t really have that feeling there!

Also, the last couple nights I’ve been waking up in the middle of the night for a period where I kind of just toss and turn in bed 75% asleep for a bit until I finally get fully back to sleep, and it almost feels like my heart is restless and is making my mind run, or it is simply just not letting my body get comfortable enough to fall back asleep. I don’t know if this is what people describe as restlessness? I’m not having rapid heartbeats and breathing or anything like that (unless I wake up from a nightmare where I couldn’t breathe like the other night!), but my body and mind just feel unsettled when this happens, even though I pretty much remain half asleep. (My body doesn’t FULLY wake me up to the point where I’d get out of bed, unless I have to go to the bathroom. Which is something I do at some point on most nights.)

Ive noticed I have had this half-waking up-unsettled mind-heart-restlessness happen more often in the last year and a half since I first CT’d and during subsequent reducing of dosages. It seemed to have almost completely gone away a little bit more after I completely dropped off the medicine a few weeks ago, but now it’s kinda back. Perhaps I didnt used to have the issue much because I was on really large dosages of 60 or 90 mg.

Anyway, the issues that still remain are making me think maybe I should give it a couple more days at 1mg, and then possibly go up to 1.5 mg anyway, to see if maybe even that small increase will make a difference in the remaining issues. I’m at 6 beads now...so 1.5 mg would be 9.

Should I try an even smaller increase of 1 or 2 additional beads? I’m not sure if only 1 or 2 more beads would have an effect instead of just going up 3 more beads. I don’t even know if going up to 1.5 mg would make any additional difference, but since I’m only at 1mg now, and it has seemed to make the tiniest of differences the last couple days, maybe...

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DavidfromTexas

DavidfromTexas

Since I always work at nights, and I am trying to take my pill at the same time day to day more than I ever used to, I am considering making the transition to taking my daily dose early in the morning as opposed to late at night. That way I can set my alarm every morning for 8 or so and take it real quick and go back to sleep. I hardly ever have anything I have to do that early in the day, so there should be less chance of me missing a dose like I might if I have to take the dose with me on the go or at work. That way it’s out of the way by the beginning of every day. When I tried taking it in the mornings before, I was on a much higher dose of 30, 60, or 90mg which may have had an additional effect of making me tired during the day.

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DavidfromTexas

DavidfromTexas

2:40am Woke up in the middle of the night sweating from a nightmare where I couldn’t breathe. I used to have these more often where I would wake up gasping for air (thought it might have been sleep apnea, but tests were never able to get any results cuz I can’t sleep with the gear on). Anyway, hasn’t been happening very much lately, until this one.

9:00am Finally got out of bed after snoozing the alarm a few times. Woke up a little more tired than recently.

11:40am Ate lunch (pasta)

I am feeling just slightly more of that underlying anxious feeling compared to the very calm day I had yesterday. Still only under the surface today.

5:00pm Got to work and ate dinner.

1:00am Took 1mg Duloxetine. Left work.

Once again I felt much more at ease by the end of my shift. Being forced to focus on something else definitely eases me up after a while.

1:30am Went our with a couple coworkers for a birthday. They drank, I had water.

2:30am Got home, are some cereal, almonds, and he last slice of the turtle pie I had in the freezer.

3:15am Went to bed

4:30am My phone rang, and I believe that is what woke me up. Tossed and turned half asleep for a bit before being able to fall back to sleep.

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DavidfromTexas

DavidfromTexas

Hey guys. Dr Ranel Larsen has gotten back to me via email and would like to give me a call to try to answer the questions I have about the compounding options. So I just wanted to list what I already want to ask here and see if there’s anything y’all would add.

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DavidfromTexas

DavidfromTexas

11:00am Got out of bed. Felt the small underlying anxiety like usual. Nothing huge, but it’s there.

1:00pm Ate lunch.

3:00pm Got to work.

5:00pm Ate small dinner at work.

9:00pm Done with work, and once again the underlying anxiety is gone and I feel very calm inside. I am starting to wonder if it has anything to do with the day wearing on more as well as just simply being just doing something. Something about waking up every day gives me that underlying anxiety feeling.

9:30pm Got home from work earlier than usual. Immediately made a pizza and ate.

Watched movie with my roommates.

1:00am Took 1mg duloxetine.

2:30am Went to bed.

I have stopped reading online as much as I was a couple weeks ago, I’ve been trying to focus on just getting better one step at a time, and that means allowing the medicine to start work again. I think the meds have made a tiny difference in my emotional edginess, but perhaps an even bigger difference was made by me not reading as much, and thus not incessantly worrying on a topic for hours at a time. It’s probably a combination of both the meds and my attempts to resist upsetting myself.

MONDAY AUG 5 (day 12)

11:15am Woke up for good. Feeling that underlying anxious feeling. It almost feels like it’s the same old routine in my day to day life that might be making me feel that way, almost like I’m tired and weary of where I have been at in my life for the last few years. I feel like I might need a change of scenery or something.

12:00pm Ate lunch (leftover pizza)

1:30-4:00pm Worked on vocal exercises and tried recording some more

5:00pm Went outside for the first time today and walked around the neighborhood for about an hour while I talked to Mom on the phone.

6:00pm Watched a movie with roommate

7:45pm Went out to grab food, came back and ate while watching more tv.

9:00pm Started worrying about other possible issues that might be popping up in my life, worrying very easily about them because I’m scared of adding any other troubles to my life right now.

11:30pm Took a nice long shower, broke down and prayed heavily to God to help me get through these things and anything else coming my way. I have a lot of regret because all of my problems I’m experiencing right now could have been prevented if I did things differently in the past. I don’t know how many more bad things I can handle.

12:15am Made some popcorn and am sitting back down to watch something until bedtime.

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DavidfromTexas

DavidfromTexas

So she would be the authority that would know the most details about what the PCCA member compounding pharmacies would be using in their formula when they compound the powder version.

As as far as up-dosing, I am wanting to try to get rid of the underlying anxiety/sense of gloom that I wake up with most days. I describe it in my notes.

The emotional edginess has seemed to calm down slightly since being on 1mg, BUT that could also be due to reading a lot less about the issues I’m facing and allowing the initial shock of these discoveries to wear off.

Either way, I wake up with that anxiety and gloom below the surface, and as the day wears on and into the evening it seems to dissipate, whether it’s because I’m at work or busy doing something else or just get to feel more relaxed in the night time. I don’t know. But I am just pretty consistently waking up with it there. It hasnt been boiling over into attacks or anything like that. But it’s just there.

My sleep schedule has never been very regular because of what I do for work. I work dinner shifts in a restaurant, so my bedtimes have always varied a little, but have always been on the later side. For the last 7 years I have worked nights and my sleep schedule has been like this.

HOWEVER I used to sleep for 11 or even 12 hours. Way too much. Lately my body has been back to waking me up at 8 hours, so I think that’s good.

The “taking my pill at 8” thought was just brainstorming, as I am trying to reduce the likelihood of forgetting or being without a dose at some point.

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DavidfromTexas

DavidfromTexas

I am taking my first dose of 8 beads tonight. That’s up 2 beads from the original 6 (1mg).

I have run into an issue with the capsules. I have been putting the divided beads back into the original 20mg capsules they came in, however in the process some of the capsules are ruined because they are tough to get apart in the first place and they crack. That leaves me with a shortage of capsules and I do not trust the gelatin capsules I bought because they are not enteric coated.

I have looked at the few “enteric coated” empty capsules that can be bought on Amazon and am not sure whether to trust the enteric quality of those either.

I do still have a handful of bottles of 30 mg and 60 mg capsules from this past year, and I’m wondering if it would be safe for me to just put the divided beads back into THOSE, even though there would surely be some powder residue left in them from their original 30 or 60 mg beads...Any thoughts?

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ChessieCat

ChessieCat

I think you might be overthinking things. The beads within a capsule are enteric coated. It may be that the original capsules of the Cymbalta are just regular gelatin. You could phone the manufacturer to find out.

Hypromellose (INN), short for hydroxypropyl methylcellulose (HPMC), is a semisynthetic, inert, viscoelastic polymer used as eye drops, as well as an excipient and controlled-delivery component in oral medicaments, found in a variety of commercial products.

Hypromellose phthalate (hydroxypropyl methylcellulose phthalate, or HPMCP) is a phthalic acid ester of hydroxypropyl methylcellulose. In the pharmaceutical industry, hypromellose phthalate is used as a coating agent for tablets and granules. It is a colorless, odorless white powder.[1]

Hypromellose phthalate was introduced in 1971 as a cellulose derivative for enteric coating. An enteric coating agent is used to protect drugs from degradation by gastric acid or to present them from causing side effects in the stomach. It is widely used as an enteric coating agent by the pharmaceutical industry.

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DavidfromTexas

DavidfromTexas

@ChessieCat, @Altostrata, and everyone else who would need to know. After continuing to search for answers I happened upon this thread on the cymbaltawithdrawal forums discussing exactly this topic just a couple months ago...

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ChessieCat

ChessieCat

This is why we recommend doing a cross over when changing form of a drug, be that tablet/capsule to liquid or vice versa, brand/generic or generic to brand, or when changing generics. Each combo for 3-7 days (or longer) 3/4 + 1/4, 1/2 + 1/2, 1/4 + 3/4. This is gentler on the system.

We do have some members here who have experienced issues when they changed over to generic, even after doing a cross over. A couple have continued to have problems and changed back the previous brand/generic. About 1 year into getting my Pristiq compounded I was offered generic but said no. I decided to stick with what I had been taking.

As long as you stick to the same brand/generic it's generally okay. All we can do is the best with what is available to us. One member had some of her compounded capsules tested for dose consistency and there was a fairly large amount of difference in them. I could have started worrying about my capsules, but I don't think it's really worth it. If I start having ongoing problems then I would probably look into it.

The really big issue is if you are unable to get the same as you were taking. There have been some members who have had that happen when the first type is no longer available and they have had no choice but to change and have had the added difficulty of not being able to do a cross over.

If you use gelatin capsules and put the beads into those, they will dissolve in the stomach but the beads, being enteric and not changed from the "original" will last until they get past the stomach.

If you use enteric capsules then once they get past the stomach the capsule will have to break down before the beads do. The beads may end up getting further down the system than they "should" and you may not get the same dose.

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DavidfromTexas

DavidfromTexas

In that thread that I posted the link to, they discuss the issue of not using the correct capsule (enteric or non-enteric), that the complications could be toxic to the stomach and result in illness! Apparently the enteric beads are toxic to the stomach. I would think this is a very big deal because not only will you not be absorbing as much of the medicine as you need, but it can make you sick on top of it.

I contacted Rising Pharmaceuticals, the manufacturer that makes the prescription I’ve been using, and the lady I spoke to was unable to give me a satisfactory answer about the coating of the capsules with confidence. And she said there was nobody else I’d be able to contact in order to get a definitive answer.

10:00am Woke up when I got a call from the PCCA pharmacist to answer my questions.

12:00pm Woke up for good after going back to sleep for a short period after the phone call

12:30pm Ate pasta. Started further researching my options for dosage forms of Duloxetine. It was very stressful.

4:00pm Had a follow-up chiropractor appt because my back has been bothering me, mainly at work.

5:00pm Spoke to Mom about my stress and what my options are right now to solve my issues.

9:30pm Taped an audition with a friend

11:30pm Back home to relax and watch some tv before bed

1:15am Took 8 bead dose of duloxetine

2:00am Went to sleep

I am thinking I need to continue up-dosing until I get more comfortable. I am still obsessing over things, mainly the mental issues and how to fix it and what the best course of action is. Which is ironic. I know this means that my eventual tapering will be a longer process.

I’m thinking I may have to work my way up to around 5 mg or something, who knows...I may need to get closer to where I was at my last full dose at 20 mg.

I have started taking the 8 beads now as opposed to 6. How should I up-dose? One week per new additional dose? I’m thinking maybe adding 2 beads a week?

There are 2 other things I could try—the compounded powder, or a completely different drug altogether.

-The compounded powder would get more expensive the higher the dosage. It’s already $200 (out of pocket) for a 1mg dose. I am checking today with my insurance company if they would cover any compounded powder prescription.

-OR again I could try a completely different drug altogether. I was on Zoloft for several years when I first went on antidepressants, so I know that at least back then my system did okay with it. Maybe it would again? I’m just trying to think what might be easier for me to eventually taper off of. Both Zoloft and Prozac can be compounded much easier than Cymbalta, right?

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DavidfromTexas

DavidfromTexas

Does anybody know what the lowest commercially available dose of Zoloft and Prozac are, without needing to be compounded?

I am seriously starting to consider whether a change of medicine would be best for me, if it is easier to taper off of due to lower available doses and being easier to compound than cymbalta.

Otherwise I am also seriously considering just taking the leap and going back to taking the 20mg pill and seeing how it works out. As we know, I have gone back onto an even larger dose of 30mg TWICE after CT’ing from 30mg to 0 each time. And if I stay on a consistent dose of 20mg or whatever for several months or even a full year, that SHOULD allow for consistent healing of my receptors and stabilization of any withdrawal symptoms, right?

I am also doing a lot of thinking about once I re-stabilize, whether I will even want to try getting off the medicine again. Especially if I am able to be happy and symptom free while on it.

Im only thinking that making a large jump in dosage could be a possibility for me because I’ve already done it without complications (at least physically) twice before. And since I have been experiencing almost 0 physical side effects since coming completely off of the drug at the beginning of July, WHY SHOULD I NOT expect that going back on a dose of 20mg or so would relieve the emotional symptoms and stress I’m feeling and also NOT cause any extra physical or emotional adverse reactions??